I had a RNY in 2006. I was 283 pounds on the day of surgery and I lost 35 pounds- 10 the first week and 25 over the next few months. I'm now pushing 400 pounds. While my pouch is still small, my stoma has stretched and I have to eat every 3 1/2 hours. I get reactive hypoglycemia and some serious dumping, and every day is a struggle to keep things stable. After researching and talking with some bariatric doctors, it sounds like a revision to a ds may help me a lot.

I have Kaiser insurance. I have been jumping through their hoops to see a bariatric surgeon to ask for a referral to an outside doctor who would do a revision and I got to meet with that surgeon (Kaiser)  today. He was very frank (which I appreciated) and told me that Kaiser has never referred someone out for a revision, and he was very much opposed to the idea of a duodenal switch. OK, I hear yoru concerns and I'm glad you voiced them. But he went on to tell me that my lack of weight loss and regain was all behavioral. Um, I was eating 600 calories right after surgery and not losing weight- that's behavioral??? He said that my pouch was doing its job because I fill up quickly. When I said that I also empty quickly, he said that just because I was hungry did not mean that I needed to eat.

OMG- then why have any bariatric surgery? Isn't the whole point to help you keep from getting so hungry? If I'm not eating even though I'm hungry, well, isn't that just a diet? I need the assistance of the "tool" that bariatric surgery provides. If that procedure leaves me hungrier than ever in the end, I don't consider that a success.

He said repeatedly that my pouch was doing its job beacuse I fill up quickly and that my lack of weight loss is behavioral. I will own that I gained weight because of what I'm eating now, but I will not accept that my inability to lose weight eating 600 calories a day was my fault. It felt like the old- I can blame you for anything because you're fat. I realize that I'm just whining here, but I really feel like I've been kicked. Trying to stay positive, but I'm tired of a lifetime of being kicked because I am fat.

I'm going to go through the appeals process and I told him so. He then informed me that he is the person on the regional level who makes the decision to refer someone outside of Kaiser and that they have never sent someone outside for a revision (lovely). He would not even entertain the idea of reducing my stoma to give me a fighting chance. My pouch is doing its job and my weight gain is strictly behavioral.

Grrrr.

Hi there!  What kaiser are you going to?  Also why do you need to get an outside referal when kaiser can do the revision?  I have some thoughts and ideas for you but need to know which one.    Don't you just love it when a surgeon tells you that you failed due to it being behavioral?!?!?!? 

 Hi- The Kaiser bariatric program I worked with is in South San Francisco (I'm in San Jose). To my knowledge, Kaiser doesn't do the DS and certainly not a revision to a DS. The doctor I saw yesterday (who was the surgeon who performed my RNY 6 years ago) told me that he is the doctor (along with one other) at the regional level who makes the decisions about cases, and he was very anti-DS. 

Having said that- what are your thoughts? Thanks. 

I go there and on monday I am going to see my dr regarding revising to the sleeve.    I will let you know...   The head of bariatrics there is a woman who specializes in obesity.  Your dr sounds like a pom pas ass!!!
I know that they don't care for the ds but there must be other options.

I will see what I can find out what I can!

First of all....Shame on that DR!  I'd like to smack him for you! 

Second, the ONLY surgeons in CA that are experienced enough to do a RNY to DS revision are Dr. Rabkin and Dr. Keshishian.  The ONLY ones.  Do not pass go, do not collect $200.  The ONLY ones.  There are a few more in the US, but they are the closest ones to you.  

I encourage you to post over on the DS forum as well.

 thanks for your replies. I am working with Dr Rabkin to get my revision- thanks to these boards, it seems clear that he is one of very few experienced enough to do it (and he is the most non-judgmental doctors I have ever encountered). I'm very fortunate to have him in my own backyard and his office has been walking me through the steps to take to get this approved.

Good luck, ann- I hope that your experience is better than mine. Kaiser SSF pre-op was excellent- I think they do some really good things. But I also think they have some things to learn.

BTW, Kaiser does have at least one surgeon who does the DS in the state of California, Gary Belzberg, in Harbor City.  While he does do all the surgeries, including revision, the previous posting are straight on as to who is qualified,although I would add Dr. Jossart (San Francision) and Dr. Crooke (USC) as well.

sounds like you need some malabsorption, stick to your needs of wanting the DS, hang on, you have picked a great surgeon, don't be afraid....

 thank you- that's exactly what I needed to hear 

I'm so glad that I came across your post. The same exact thing happened to me about 3 years ago. I went to Kaiser Santa Teresa seeking a revison and they did a Barium Swallow and said everything looked fine. Of course I was not satisified with that answer, so they sent me back to Kaiser South San Francisco to speak with a surgeon who was pretty much telling me the same thing they told you. My original RNY surgeon left Kaiser about a year after my surgery, so I was not able to speak to him, it was someone different than who you spoke too.

I had RNY back in 2002 and South San Francisco Kaiser and did very well for the first year. I lost a total of 120 lbs within a year. Then I got pregnant and gained some weight back. Now several years & 2 additional pregnancies later, I have gained almost all of the weight back.

I have since changed insurance plans to Valley Health Plan and have seeked a revision with my new doctor *****ferred me to Stanford and it is deja vu all over again. They did a Barium Swallow about 2 months ago and are telling me the axact same thing Kaiser told me. They also told me that I should try Alli Weight-Loss Pills and work on eating healthy, portion control and exercise. I suppose to follow up with them next month so see if I have lost any weight on my own. The Alli pills are not working for me. I'm so frustrated. I'm even considering going to Mexico.

Good Luck

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Hi there!  I went to my dr on monday and after a long talk we both chose at this point to add a little fill and after one month go back.   The band was not for everyone , but we need to give it another chance.

I asked if revisions are ever done and they do do them.  600 calories a day is not healthy and we all build up to a reasonable daily calorie target to continue losing.   They all meet to discuss various patients, and you can choose to see the head of the department.

All I could find out from nurses etc I saw there.

E-mail me at missvonbatt@yahoo.com.

 thanks for the info Ann- I'm hoping this will turn out the way I'm going, but if it doesn't, I'll dig a little deeper through Kaiser. I'm ready to be done having surgeries.

Beautywithin- this really sucks, doesn't it? If we were able to stick to simple diet and exercise plans we would not need the help that surgery provides. Don't they get that we have gone that route time and time again and we are turning to surgery only after having "failed" everything else? I'm sure that one day all bariatric surgeons will realize that our eating disorders are more that "non-compliance", and maybe they'll have a little compassion.

In the mean time...... maybe we're the trailblazers for those who will come after us.. ....sigh.......